June 30, 2022
General Assembly Newsletter
Stay up-to-date on what's new at the Department of Health Care Policy & Financing with our newsletter created specifically for the Colorado General Assembly.
Editor's Note
This newsletter is published monthly while the legislature is in session, and quarterly outside of the legislative session.
 
Please continue to direct any questions or constituent issues to the Department's legislative team: 
A Message from Executive Director Kim Bimestefer 
Kim Bimestefer
Historic Legislative Session for Health Policy 
Thank you for your partnership in a historic legislative session for health policy. Together, we are making transformative investments in behavioral health, workforce, pandemic management, affordability and coverage. While the Department is tracking and implementing more than 50 bills passed this session, here are some of the highlights:

Behavioral Health. Twenty bills touched behavioral health and substance use, many memorializing Behavioral Health Transformational Task Force recommendations including the investment of $450 million in American Rescue Plan Act (ARPA) dollars. HB 22-1278 creates the Behavioral Health Administration, a landmark achievement that will help coordinate the efforts across state agencies to transform the behavioral health system, achieve shared goals and pursue a shared vision that puts Coloradans first.

Supporting Workforce, Older Adults & Pandemic Management. Several bills will help Colorado move from pandemic responsiveness to endemic management and pandemic readiness. They include measures focused on vaccinating, testing and treating through hospital system owned primary care providers as well as hospital staffing improvements (HB 22-1401); targeted funding to support nursing homes (HB 22-1247); and higher base wages for nursing home workers (HB 22-1333) as well as home and community-based direct care workers (HB22-1188). Also, the Department is thrilled at the passage of SB 22-203, which creates a more efficient, effective and transparent oversight structure for Program of All-Inclusive Care for the Elderly (PACE) - an all-inclusive benefit for older adults who need long-term services and supports.

Affordability. As stated by Gov. Polis, this was a landmark legislative session for saving people money on health care. HB 22-1285 increases hospital price transparency, predicted to drive down outlier prices impacting communities. Additionally, HB 22-1370 will pass along drug manufacturer rebates to employers and consumers – valued at more than 16% of overall drug costs for those not sharing in rebates now. This bill represented one of the policy recommendations in the Department’s 2021 Reducing Prescription Drug Costs in Colorado Report. Also, SB 22-200 provides funding for rural hospitals to invest in affordability solutions that help reduce rural hospital and clinic prices. Finally, the Long Bill supported the Department’s expansion of value-based payment models, designed to improve quality, reduce disparities and drive affordability across primary care, maternity care, prescription drugs and specialty care.

Coverage. Significant progress was made on expanding health coverage. Thanks to HB 22-1289, more children and pregnant people will be eligible for health coverage through a new program the Department will administer to reduce the uninsured rate. This bill also enables HCPF to move eligible individuals from Health First Colorado (Colorado’s Medicaid program) to Child Health Plan Plus (CHP+) at the end of the public health emergency without member action by eliminating the annual CHP+ enrollment fee. SB 22-081 also passed, supporting coverage transitions and improving awareness of financial assistance that makes coverage more affordable to help keep Coloradans covered.

Thank you for your collaboration on advancing such important policies. We appreciate the hard work, passion and expertise of our elected officials, advocates, providers and stakeholders. For more information, please visit our Legislator Resource Center.
HCPF 2022 Legislative Agenda
We are happy to announce that the 2022 legislative session was a bipartisan success for HCPF’s legislative agenda. Thank you for your support in passing all of the Department's agenda items this year, including bills to support PACE oversight and accountability, increase hospital transparency in the state, stimulus for rural hospitals and HB 22-1329, this year’s Long Bill. As you can see, we had a very busy legislative session! Here is a rundown of the Department’s Agenda Bills for the year:

SB 22-203 PACE Oversight and Accountability. PACE is an all-inclusive benefit for older adults who need long-term services and supports. PACE provides a comprehensive medical and social service delivery system and uses an interdisciplinary team approach. This new law authorizes HCPF to work with stakeholders to develop a plan to establish formal oversight requirements and improve the state PACE oversight structure and process in the absence of active federal oversight. The bill, as passed, will create a more efficient, effective and transparent oversight structure of the program at the state level, while leveraging what is already in place.

SB 22-236 Redesign Medicaid Provider Rate Review Advisory Committee (MPRRAC). Established in 2015, the MPRRAC provides input to the Department related to provider reimbursements, rate setting and rate review under the Medicaid program. This new state law will redesign the MPRRAC to increase its effectiveness and efficiency, while ensuring providers, consumers and stakeholders have an opportunity to provide input during the rate review process. HCPF worked closely with the Joint Budget Committee on the law, which will make changes to the MPRRAC membership, reporting requirements and timing, review schedule and operations.

SB 22-052 Medicaid Adjusted Gross Income Compliance with Federal Requirements. In 2019, the Office of the Colorado State Auditor found that the Department’s statutory Medicaid adjusted gross income eligibility requirements do not meet current federal requirements, despite the Department applying the federal requirements to its eligibility process and procedures. This new state law addresses the audit findings, brings Colorado into compliance with federal requirements and mitigates future compliance issues.

HB 22-1247 Skilled Nursing Facility Enhanced Payments. This new state law provides $27,001,00 in state fiscal year (SFY) 2021-22, including $17,000,500 General Fund to address staffing and other pandemic-driven issues in skilled nursing facilities. Nursing facilities, which have struggled to retain workers under current Medicaid rate caps. The payments authorized in this bill will be used for: workforce and industry sustainability measures, including to hire and retain staff, and hospital complex need and correctional compassionate release admit incentives to address hospital discharge delays by incentivizing nursing facilities to admit these populations.

HB 22-1285 Hospital Transparency. Under federal law, hospitals are required to post standard changes on a publicly available website as of Jan. 1, 2021. This new state law will help ensure federal compliance by prohibiting hospitals licensed and certified by the Department of Public Health & Environment (CDPHE) from pursuing collection against a patient owing debt, if the hospital was not in compliance with the federal hospital price transparency laws on the date that the items or services were provided to the patient. The state law also allows a patient to file suit to determine if the hospital was out of compliance and poses a few different penalties if necessary.

SB 22-200 Rural Hospital Stimulus Grant Program. This law creates a grant program that will give qualified hospitals serving rural communities in Colorado the resources to modernize their IT infrastructure and invest in projects to expand affordable access to health care. It creates a $10,000,000 rural provider access and affordability fund in the state treasury to fund the program, while HCPF will be responsible for administering the funds and the Medical Services Board will adopt guidelines to determine which providers will be eligible.

Other bills the Department supported: 
  • Three bills part of the Governor’s pandemic readiness bill package including
  • HB 22-1352 PPE Stockpile for Declared Disaster Emergencies, which requires the Department of Public Safety to secure and maintain a stockpile of essential materials that are available for distribution should the Governor declare a disaster emergency.
  • SB 22-226 Program to Support Health-care Workforce, which creates a package of grant programs that will harness existing state initiatives and resources to ensure Colorado’s health care workforce is adequately supported to meet the needs of the state.
  • HB22-1401 Hospital Nurse Staffing Standards, which requires hospitals in the state to establish a nurse staffing committee, develop and publish a nurse staffing plan and risk fines if their staffed-bed capacity falls before 80% of the required baseline. 
  • HB 22-1031 Consumer Right to Repair Powered Wheelchairs compels powered wheelchair manufacturers to provide any necessary documentation and tools to ensure an individual or a wheelchair repair provider has the tools to make their own wheelchair repairs should they chose to. 
  • HB 22-1068 Medicaid Reimbursement for Therapy Using Equines makes reimbursement available for certain therapies using equine movement, contingent upon federal approval. 
  • HB 22-1114 Transportation Services for Medicaid Waiver Recipients allows transportation network companies (TNCs) to provide non-medical transportation services to persons enrolled in certain Medicaid waiver programs beginning July 1, 2024. The bill requires HCPF to submit a report to the legislature by January 2024 identifying ways to incentivize and increase transportation provider participation and with a plan for operationalizing this service for members.
  • HB 22-1268 Medicaid Mental Health Reimbursement Rates Report requires an audit of Medicaid reimbursement rates for independent mental health and substance abuse treatment providers and the publication of a cost report for community mental health centers.
  • HB 22-1278 Behavioral Health Administration creates the Behavioral Health Administration in the Department of Human Services (CDHS) and charges it with creating a coordinated, cohesive, and effective behavioral health system in Colorado. The new law is the culmination of years of work on transforming the state’s behavioral health care system. 
  • HB 22-1289 Health Benefits for Colorado Children and Pregnant Persons expands Medicaid coverage to low-income pregnant people and children, regardless of immigration status in the state. The law also requires the Insurance Commissioner to improve the quality of health insurance coverage through the Health Insurance Affordability Enterprise and extends a survey of birthing parents indefinitely. 
  • HB 22-1290 Changes to Medicaid for Wheelchair Repairs makes changes to the way Medicaid covers powered wheelchair repairs. It prohibits HCPF from requiring prior authorization for any repair of complex rehabilitation technology, while also requiring the Department to engage in a stakeholder process and promulgate rules establishing repair metrics for all complex rehabilitation technology suppliers. Three years after the repair metrics rules are established, HCPF may engage in a stakeholder process to determine the need for additional accountability measures including financial penalties, audits or other tools. 
  • HB 22-1302 Health-care Practice Transformation creates the primary care and behavioral health statewide integration grant program in HCPF to provide grants to primary care clinics for implementation of evidence-based clinical integration care models. 
  • HB 22-1303 Increase Residential Behavioral Health Beds requires both CDHS and HCPF to partner to create at least 125 beds at mental health residential facilities throughout the state based on need. It also creates 16 additional in-patient beds at the mental health institute at Fort Logan.
  • HB 22-1370 Coverage Requirements for Health Care Products modifies prescription drug coverages, prohibits changes in a carrier’s prescription drug coverage formulary during the plan year and requires reporting and analysis on prescription drug rebates. 
  • SB 22-081 Health Exchange Education Campaign appropriates money to Connect for Health Colorado and HCPF to create and implement a public awareness and education campaign to inform consumers about health care coverage options. The law will help HCPF serve members transitioning coverage as a result of the PHE unwind.
  • SB 22-156 Medicaid Prior Authorization and Recovery of Payment makes changes to the prior authorization and recoupment processes by prohibiting prepaid inpatient health plans from requiring prior authorizations for certain services and from certain payment recoveries. 
  • SB 22-177 Investments in Care Coordination Infrastructure requires the Behavioral Health Administration to make certain investments including in training new and existing navigators on the behavioral health safety net system services, as it develops the statewide care coordination infrastructure and requires the infrastructure to include a cloud-based platform. 
  • SB 22-196 Health Needs of Persons in Criminal Justice System provides funding for behavioral health needs and continuity of care for individuals in the criminal justice system. 
  • SB 22-235 County Administration of Public Assistance Programs requires the development and implementation of a funding model for the administration of public medical assistance. Among its provisions, the new law compels HCPF to work in coordination with CDHS and county departments to develop a scope of work for the comprehensive assessment of best practices related to the administration of public and medical assistance programs and conduct that assessment to evaluate the existing infrastructure. 
HCPF FY 2022-23 Budget Agenda
A summary of the Department’s provisions included in the FY 2022-23 Long Appropriations Bill or Long Bill (HB 22-1329) is now posted on the Department’s website. Each year, the Long Bill includes the Department’s budget requests and other provisions passed by the General Assembly to fund the operations of state government. HCPF’s budget items for this year focused on prioritizing and protecting the needs of members while increasing provider rates, expanding benefits for members receiving services offered through Home and Community-Based Services (HCBS) waivers and supporting our county partners. A few examples of our successful budget requests funded by the General Assembly include:

  • R6 Value Based Payments: HCPF received funding for the planning and implementation of three alternative payment models (APMs), including the Pharmacy prescriber tool APM and the Primary Care and Pediatrics APMs. The JBC allocated full funding for the APMs to the Department, including the FTE, contractor and systems costs.
  • R7 Utilization Management: The Department received funding to expand and strengthen utilization management (UM) measures in Colorado’s Medicaid program. The Department received funding to compensate HCPF’s UM vendor for expanding medical necessity reviews for outpatient medical services and physician administered drugs newly identified as high-risk for fraud, overutilization, or that are not routinely considered medically necessary.
  • R8 County Administration, Oversight and Accountability: HCPF received a funding adjustment to backfill some of the state’s annual funding deficit of its County Administration appropriations. This included increases in funding for pay-for-performance through the County Incentives Program allocation, hire additional staff to provide proper fiscal and programmatic oversight of county administration services and reduce the time it takes to conduct on-site compliance reviews of all 64 counties.
  • R9 Office of Community Living (OCL) Living Program Enhancements: The Department received funding to increase rates and expand benefits for services offered through the Home and Community-Based Services (HCBS) waivers, increase provider bed capacity and create additional opportunities for care in the community.
  • R10 Provider Rate Adjustments: HCPF received funding for a 2.0% across-the-board rate increase for providers. Additionally, the Department received funding for certain targeted adjustments to provider rates across several service categories, including an increase of DME rates, a temporary increase to certain DME codes, an increase to transportation rates, an increase to speech therapy rates and an increase to physical and occupational therapy rates.
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Register Now for HCPF Annual Stakeholder Webinar
Please register to join Health Care Policy & Financing leaders for a virtual webinar on July 19, from 9-11 a.m. This event will share what we accomplished together last year, address priorities for next fiscal year, and invite stakeholder feedback and comments.
Reproductive Health Equity-Related Bills
The Department is operationalizing the implementation of a series of reproductive health equity-related bills passed in mid-2021. Effective July 1, 2022, Health First Colorado and CHP+ will: 

  • Ensure that any pregnant person enrolled in Health First Colorado or CHP+ is guaranteed full benefits up to 12 months after they give birth or when their pregnancy ends (SB21-194) 
  • Cover family planning and family planning-related services provided by any enrolled provider at no cost to the member (SB21-016) 
  • Cover family planning services for members regardless of their immigration or citizenship status (SB21-009) 
  • Cover family planning and family planning-related services for individuals with a higher income than the standard Medicaid income limit (SB21-025) 
 
The four bills address inequities in access to care that create disparities in reproductive, maternal and infant health outcomes. The Department is executing a comprehensive communications plan that involves a multi-faceted approach to socialize the go-live to key audiences: members, providers, RAEs, counties, partners, internal staff, advocates, and others. The Department is also working with community partners to publicize the expanded coverage opportunities.
HCPF Submits New Reports & LRFIs to the General Assembly
HCPF submitted new reports and LRFIs to the General Assembly since the last newsletter. Find examples of them below, all reports are on the Legislator Resource Center Page: 
 
Member Spotlight
Alison caught a virus and never got better. Because of the support she receives from Health First Colorado, she doesn’t have to worry about the expensive medical bills or decide whether she has to skip going to the doctor this time. Alison is able to use the precious energy she has to support others, which has given her life new meaning. Other Health First Colorado members want Coloradans to know that they may qualify for quality health care coverage. Learn more at HealthFirstColorado.com.
Member Contact Center
One in four Coloradans are covered by Health First Colorado (Colorado’s Medicaid program). Coloradans from across the state and all walks of life get their health care from Health First Colorado, including people who never thought they’d need public health insurance. At Health First Colorado, we hire Member Contact Center staff with a passion for service and an empathetic heart.
Legislator Resource Center 
The Legislator Resource Center on our website is available to help legislators and legislative staff easily find information. It includes links to reports, fact sheets and overviews of the budget process to help inform legislators. 
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